吸收倒刺线在双镜联合保胆取石术中的临床应用

Clinical application of absorbable barbs line in gallbladderprotected lithotomy by laparoscopy combined with choledochoscopy

摘要:

目的 探讨可吸收倒刺线在腹腔镜联合胆道镜（以下简称双镜联合）保胆取石术中的临床应用。 方法 回顾性分析2015 年6 月—2018 年1 月在大连大学附属中山医院胆石病微创外科成功行双镜联合保胆 取石手术治疗的209 例患者临床资料。其中，128 例采用可吸收倒刺线缝合胆囊者作为倒刺线组，81 例采用 普通可吸收缝线者作为普通组。结果 两组基线资料比较，差异无统计学意义（P >0.05）。两组术中出血量、 住院时间比较，差异无统计学意义（P >0.05）。倒刺线组胆囊缝合时间（5.52±1.32）min、手术时间（64.87± 16.36）min 低于普通组胆囊缝合时间（6.19±1.64）min、手术时间（72.80±25.09）min（P <0.05）。倒刺线 组无术后胆漏，普通组术后胆漏发生率为6.17%（P <0.05）。3 例术后胆漏在积极保守治疗后缓解，2 例在行内 镜下鼻胆管引流治疗后缓解。术后随访3 ～ 6 个月，结石复发13 例，6 例给予腹腔镜下胆囊切除；7 例行内 镜下乳头括约肌切开/ 内镜下乳头括约肌球囊扩张+ 鼻胆管引流等治疗。无死亡病例。结论 可吸收倒刺线 用于双镜联合保胆取石术中一期缝合胆囊安全可行，其可降低腹腔镜下胆囊缝合难度、缩短胆囊缝合时间及 手术时间，降低术后胆漏发生率，临床优势明显。

Abstract:

Objective To investigate the clinical application of absorbable barbs line in gallbladder-protected lithotomy by laparoscopy combined with choledochoscopy. Methods A retrospective analysis was used to analyze the clinical data of 209 patients treated with gallbladder-protected lithotomy by laparoscopy combined with choledochoscopy in our department from June 2015 to January 2018. Among them, the patients whose gallbladders were sutured with absorbable barbs line were enrolled in barbs line group, and patients whose gallbladders were sutured with common absorbable line were enrolled in control group. Results Among 209 patients, the barbs line group contained 128 cases, the control group contained 81 cases. There was no significant difference in general baseline data between the two groups (P > 0.05). There was no significant difference in intraoperative bleeding volume and average hospitalization time between the two groups (P > 0.05). In barbs line group, the suturing gallbladder time was (5.52 ± 1.32) min, and the operation time was (64.87 ± 16.36) min; in control group, the suture gallbladder time was (6.19 ± 1.64) min, and the operation time was (72.80 ± 25.09) min; and both time in the barbs line group was significantly less than the control group (P < 0.05). In barbs line group, there was no bile leakage occurred, but the incidence of bile leakage was 6.17% (5/81) in control group. There was a significant difference between the two groups (P < 0.05). Three cases of bile leakage were relieved after conservative treatment, and two cases were relieved after endoscopic nasobiliary drainage. The follow-up period was 3-6 months. Stone recurrence happened in 13 cases. Then 6 cases underwent laparoscopic cholecystectomy and other 7 patients of sludge stones underwent endoscopic sphincterotomy/endoscopic papillary balloon dilatation plus endoscopic nasobiliary drainage, then the sludge stones disappeared. There were no death related to operation. Conclusion It is safe and feasible to use absorbable barbs line to suture gallbladder in gallbladder-protected lithotomy by laparoscopy combined with choledochoscopy. It can significantly reduce the difficulty of laparoscopic suture gallbladder, shorten the suturing gallbladder time and operation time, and reduce the incidence of bile leakage after operation. It had important clinical significance and advantage.